Barriers and facilitators to knowledge translation activities within academic institutions in low- and middle-income countries

The study addresses the persistent know-do gap between public health research and policy/practice. Knowledge translation (KT) is defined as a dynamic, iterative process to synthesize, disseminate, exchange, and apply knowledge to improve health systems. Academic institutions are central to KT but face variable success. Prior work—largely from high-income countries—highlights barriers such as limited understanding of KT, challenges in planning and implementing KT, weak relationships with policymakers, and difficulties in effective research communication. A review identified four needs for researchers: understanding KT theory, integrating KT into research planning, building relationships with end users, and communicating effectively. Organizational readiness—comprising motivation and capacity—offers a lens to assess institutional drivers of KT performance, but existing tools are mostly HIC-focused and emphasize capacity over motivation. This study aims to describe needs and barriers for KT specific to LMIC academic institutions and identify readiness factors to guide capacity-building strategies.

Existing literature documents common KT barriers: limited KT knowledge and skills among researchers and end-users; inadequate institutional support, incentives, and infrastructure; weak collaboration and networking; and communication challenges. Reviews and frameworks such as CFIR and organizational readiness theories (Weiner; Dearing) emphasize multi-level influences (individual, institutional, external) and the interplay of capacity and motivation. Prior assessments are predominantly from HICs and often overlook motivational aspects. A recent LMIC-focused review (Murunga et al., 2020) confirms similar barriers and calls for deeper understanding of institutional drivers at both individual and organizational levels. This study builds on these foundations to identify context-relevant determinants for LMIC academic institutions. Additionally, the authors conducted a targeted literature search (PubMed, Google Scholar) using terms related to organizational readiness, knowledge translation, public health, barriers, facilitators, and LMICs to inform barriers/facilitators and readiness strategies used in tool development.

Design: Qualitative, multi-country study embedded within the STRIPE project. Methods included document review and key-informant interviews (KIIs), analyzed using combined deductive and inductive thematic approaches. Document review: Collected and analyzed 43 documents, including institutional organograms, websites, strategic plans of six academic partners, and public MOH documents (websites, strategic plans) to identify country health priorities, institutional directions, and key decision-makers. These data informed sampling and health priority reference points for each setting. Settings and participants: Six LMIC academic partners (Bangladesh, DRC, Ethiopia, India, Indonesia, Nigeria) and their government counterparts (MOH). Internal participants (faculty, staff, administrators) met at least one criterion: involvement in institutionally prioritized KT activities; roles in strategic/policy decisions around KT; or leadership shaping internal/external institutional contexts. External participants were policymakers engaged with the academic institution on prioritized health issues within the last two years. Participants were identified via document review and PI consultations; external participants were also identified through internal recommendations. Data collection: KIIs conducted in English, in-person or via Zoom/Skype/WhatsApp between November 2019 and January 2020; duration ~40–60 minutes. Interviews were audio-recorded, transcribed, and coded line-by-line in Dedoose. Detailed interview notes were cross-checked with transcripts. Sample: 18 KIIs across 6 countries (10 internal, 8 external). Gender: 13 men, 5 women; most external participants were men (all but one). At least one internal and one external interview per country. Analysis: Deductive coding drew on Potter and Brough’s capacity building pyramid and CFIR; inductive codes captured themes not encompassed by these frameworks (e.g., ownership, values, prioritization, trust). Combined approach informed development of a quantitative institutional readiness tool for KT. Ethics: Determined non-human subjects research by Johns Hopkins Bloomberg School of Public Health (8 October 2019).

- Documented common barriers reaffirmed: limited knowledge of KT and how to conduct it; insufficient skills; scarce resources (time, funding); limited institutional support (staffing, training, infrastructure); and the need for leadership engagement. - Three cross-cutting institutional drivers emerged: 1) Policy process complexity and soft skills: Policymaking is political and complex; researchers (especially junior) often underestimate this. Soft skills (emotional intelligence, relationship building, respectful, context-appropriate communication) are critical yet under-taught. Continuous engagement is challenging given time constraints for both researchers and policymakers. 2) Misalignment between institutional missions and incentives: Although KT may appear in mission statements, metrics and promotion pathways prioritize publications and grants, not KT. KT efforts often lack recognition and dedicated time/budget. Competing missions (teaching, research) limit time for KT. 3) Role of networks: Strong internal and external networks (with MOHs, donors, NGOs, alumni) facilitate access, trust, and resources. Institutional reputation, age, and alumni presence in government enhance KT opportunities. Networks require sustained engagement and are time-intensive to build and maintain. - CFIR-aligned observations: Weak internal structures and communication; limited training availability; cosmopolitanism/networking as facilitators; external policies/incentives from funders shape KT activities; planning and execution constrained by staffing/time/budget; stakeholder engagement is essential but difficult; KT quality, timeliness, and depth matter but are hard to achieve. - Quantitative/contextual details: 43 documents reviewed; 18 KIIs (10 internal, 8 external) across 6 LMICs; interviews conducted Nov 2019–Jan 2020; gender mix 13 men, 5 women. - Examples of potential motivators: Impact on policy/programs; mentorship and leadership modeling; institutional provision of tools, funding, platforms; recognition and incentives (financial or career development).

Findings address the research question by identifying organizational drivers of KT performance in LMIC academic institutions beyond individual-level barriers. The complexity of policymaking necessitates soft skills and ongoing engagement strategies rarely emphasized in academic training. Misaligned institutional incentives and unclear metrics diminish motivation and time allocation for KT despite mission statements referencing societal impact. Robust internal and external networks amplify capacity and acceptability of evidence in policymaking but require sustained investment of time and leadership support. The interdependence of these themes suggests that institutional readiness comprises both capacity and motivation, with multiplicative effects across structures, processes, and culture. Addressing higher-order levers—such as institutional missions, leadership engagement, and network-building—may simultaneously mitigate multiple barriers. The study underscores opportunities for academic institutions to support MOH capacity for KT and to design readiness assessments for LMIC contexts that capture both motivational and capacity domains to inform targeted capacity-building interventions.

This study contributes an institution-focused understanding of KT barriers and facilitators in LMIC academic settings and identifies three cross-cutting drivers—policy process complexity and soft skills, misalignment of missions and incentives, and the centrality of networks. In addition to confirming well-known constraints (time, funding, infrastructure, leadership engagement), the results highlight the need to integrate soft-skill development, mentorship, leadership modeling, and network strengthening into capacity-building. The insights will inform the development of a quantitative readiness assessment that incorporates both capacity and motivation tailored to LMIC contexts. Future work should develop, validate, and apply such readiness tools and evaluate institutional interventions (e.g., incentive realignment, transformational leadership, multidisciplinary team structures, dedicated KT support units) to enhance KT effectiveness and impact on policy and practice.

- External policymaker recruitment was challenging; most settings had only one MOH participant, limiting the breadth of external perspectives. - The six-country sample provides a snapshot and may not generalize to all LMIC contexts. - A single researcher conducted and analyzed interviews, raising reflexivity and bias concerns; mitigated by consistent data collection/coding, comprehensive notes, and a sequential exploratory design with explicit acknowledgment of potential bias.